Jacob Shank, MD

1. Pneumonia Severity
Index
Shank's Wee Wee Vol. 1

2. MedisGroup Cohort Study
• 1989 cohort of 38000 pts.
• Developed PSI based on
o History
o Physical Exam
o Lab0ratory Data
• Five Classifications as a risk stratification
tool
• Inappropriately used as decision tool for
disposition.1

3. Patient Outcomes Research
Team (PORT)
• Research team with multiple publications,
and validation studies up to 1996 building
from original cohort study.2
• Prediction Rule article in NEJM 1996
• http://www.nejm.org/doi/full/10.1056/N
EJM199701233360402#t=article.
• Exclusion based on HIV and recent
hospitalization3

4. Two Step Scale
• Step 1 defines class I (very low risk group)
o Age<50, HR<125, SBP>90, RR<30,
35<Temp<40 and No: Heart, Liver, Renal
disease or Cancer.
• Stage 2 delineates all others into classes
II-V based on Labs.
• Mortality in class II (0.6-0.9%) in class III
(up to 2.8%)
• Class IV and V- Strongly think about
inpatient.

5. CURB-65 and Others
• CURB-65: British Thoracic Society
• CRB-65: for people who don't like labs
• IDSA/ATS 2007 consensus guidelines
• SCAP score and SMART-COP: for
deciding ICU admission4
And the List Goes On

6. Comparisons
• 2010 Meta-analysis demonstrates
PSI/PORT to be more sensitive than
CURB-65, CURB is more specific
• Negative predictive value of all 4 scores
studied correlated well for low risk pts.5
• Second Meta-analysis in 2010 found no
difference in prediction of mortality.6

7. Summary
• Use your decision tools and use them
correctly!
• Step 1 of PORT decision tool finds low
risk patients: Age, Vitals, History.
• Use the classifications in discussions with
your consults/colleagues.
• Access all the tools at MDcalc.com

8. References
1. Loeb, M. Evidence Based Infectious Diseases. West Sussex, UK. Blackwell Publishing. 2004
2. "Pneumonia: New Prediction Model Proves Promising". AHCPR Publication No. 97-R031. 1997
3. Fine, M. et al. "A Prediction Rule to Identify Low-Risk Patients With Community-Acquire
Pneumonia". NEJM. 1997. 336:243-250
4. Marti, Christopher. et al. "Prediction of severe community-acquired pneumonia: a systematic review
and meta-analysis". Critical Care 2012, 16:R141.
5.Loke YK, Kwok CS, Niruban A, Myint PK. Value of severity scales in predicting mortality from
community-acquired pneumonia: systematic review and meta-analysis. Thorax. 2010;65:884-90
6.Chalmers JD, Singanayagam A, Akram AR, et al. Severity assessment tools for predicting mortality
in hospitalised patients with community-acquired pneumonia. Systematic review and meta-
analysis. Thorax. 2010;65:878-83